Case Study Provides Glimpse of Workers’ Comp Process

April 11, 2012

Every so often, we get to take a glimpse of hypothetical workers’ comp cases and how the process played out. One case involving a cab driver caught our attention in particular.

Arthur Ralko was a cab driver in the employ of Ardshaw Taxi Company as an independent contractor. He would lease the cab from the company for $150 per day and take calls dispatched to him. Ralko would keep the funds he would receive in cab fares.

One day while driving his cab, Ralko had an accident when the cab veered sharply to the right and hit a curb. The collision caused the airbags to deploy and caused the driver’s legs to move forward into the cab’s dashboard.

In pain, Ralko asked another cabbie passing by to call 911 where he was taken to the emergency room. Doctors performed a CAT scan and a MRI and determined the driver sustained a herniated disk and a broke tibia and fibula in the right leg.

Ralko filed a workers’ comp claim with the cab company’s insurance carrier. The company assigned 2 orthopedic surgeons – 1 as a primary, the other as a backup.

The first surgeon concluded that while painful, Ralko’s injuries were not debilitating. He recommended the driver undergo 30 days of rehabilitation then return to work.

Ralko disagreed with this assessment so he requested he see the other surgeon – after some more testing, the 2nd surgeon came to pretty much the same conclusion as the first.

Based on these findings, the insurance carrier only agreed to award Ralko lost wages for the 30 days and paid medical bills.

Disagreeing with the 2 surgeon’s conclusions and not satisfied with the insurer’s offer, Ralko hired his own doctors to evaluate his injury. One doctor concluded that his injuries were more severe and required a 90-day absence, at which time any long-term impacts can be determined. Ralko brought this information to the insurance company but was denied further compensation.

In response to the denial, Ralko turned to the courts where he filed a petition. In turn, the insurance company claimed Ralko was exaggerating his injuries and filed a Motion for Summary Judgment, which basically would evaluate the driver’s claim(s).

On the day of the hearing, the insurer entered the diagnoses of both initial surgeons into evidence. The surgeons also testified on behalf of the insurer and were thoroughly able to defend their findings under heavy cross-examination. Both were of the view that Ralko could resume work within 90 days of the date of their initial examinations.

The claimants in this case didn’t have as solid a case.

Doctors hired independently by Ralko were not willing to testify. Instead, Ralko’s attorney entered their findings as evidence and called the cabbie to the stand, who approached the bench using crutches.

Ralko testified that his injuries were causing him much hardship and that his ability to walk, sleep and work was severely limited.

Upon cross examination though, Ralko’s case really began to fall apart. Attorneys were able to obtain an admission from Ralko that he only used the crutches on the day of the hearing. They also discovered Ralko had indeed consulted with several doctors before he obtained the reports he had for the hearing. The cabbie was therefore engaging in a practice known as “doctor shopping.”

In the end, the court granted the insurer’s motion, which ended the case.

We found this case interesting because it shows how you must have solid evidence backing up any workers’ comp claims. “Doctor shopping” and other tactics likely won’t hold up to the scrutiny an insurer is likely to apply.

At the end of the day, it seems Ralko’s injuries were not to the extent he claimed. Not having a solid reason or case for seeking additional compensation can in fact backfire as this particular situation shows.

A good workers’ comp attorney would have likely not advised Ralko to pursue his claim in the fashion he was doing it.